It’s easy to advocate for vaccinating adults and teens against COVID-19. Some think it’s harder to advocate for children under 12, and for understandable reasons. Much of the world is still unvaccinated, children in general are much less affected by the coronavirus, and we don’t yet have a thorough understanding of the risks versus the benefits. But when we weigh all the pros and cons, the argument for immunizing young children is much stronger than the argument against.
Let me start with the most compelling argument for not vaccinating children: the international ethical argument. Adults around the world are at much greater risk than American children, and our doses could theoretically go elsewhere. That’s true. Unfortunately, this would require collaboration that has not yet been seen in the United States. Our doses remain our doses and not much effort is being made to distribute them worldwide in a more equitable manner. Given that using those vaccines to immunize the 48 million U.S. children under 12 who are completely unvaccinated — and who are at constant risk of COVID-19 — is the best way to provide significant benefits to everyone, the spread of the virus and future variants that develop here.
Those who oppose vaccinating younger children argue that the potential harms outweigh the benefits of immunization. They point out that children may not see as much benefit from vaccination as adults, and they may experience side effects that older adults don’t, such as young adults seem to have with myocarditis. They remind us that the real concern in the spring of 2020, when we closed schools across the country, was not that children were likely to become seriously ill. It was that they could be a vector for infecting their parents or, worse, their grandparents. The vast majority of older Americans are now vaccinated.
But last fall, when many schools went online or hybrid, it became clear that while children were at reduced risk, that risk was real. At least 354 children have died from COVID-19. Many thousands have been hospitalized. More than 4,400 have been diagnosed with childhood multisystem inflammatory syndrome (MIS-C), a “rare but serious condition associated with COVID-19,” and many more are sick, even if they have recovered fairly well. While COVID-19 is far from the danger it has posed to adults and the elderly, it is still worse for children than most flu seasons.
The predominance of the Delta variant has further complicated the discussion. Last year you could argue that children were less likely to get infected than adults, less likely to transmit diseases if they did, and were also less likely to be symptomatic. That is no longer clear. Because Delta is so much more contagious, children seem to get sick in greater numbers. Children’s wards are busier, especially in low-vaccination areas, and there is renewed concern that schools could become centers for outbreaks this fall.
It is true that all these arguments can be made to get more adults vaccinated, reducing the risk to both the young and the elderly, but efforts to do so have stalled across the country. In light of this reality, vaccinating children would still slow community transmission.
And that’s a bigger reason to immunize kids — to protect those who can’t protect themselves.
In the late 1990s, when the varicella vaccine was new, I was a young pediatrician. I’ve spent a lot of time convincing parents to vaccinate their children against chickenpox. They would argue that the disease was mild, not serious, and that the risks of the shot outweighed the benefits. However, the disease was not mild for everyone. It posed a significant risk for adults who had never had it. It also posed a risk to babies.
Even though we couldn’t vaccinate children until their first birthday, by vaccinating the older ones, we started to prevent almost all infant deaths from varicella. Vaccinating children made others safer. Even if children themselves are at lower risk, they are still part of our shared humanity, and immunizing them will help protect society as a whole.
It doesn’t have to be so abstract, though, and it shouldn’t be, if it becomes a compelling public health message. Almost all children have grandparents. Those grandparents are best protected by getting vaccinated themselves, but they remain at risk for breakthrough infections, which become more likely the more exposed they are to COVID-19. Many children have loved ones with cancer or other immunological disorders that also put them at higher risk. Many children have such conditions themselves.
Vaccinating children to protect those they love shouldn’t be a difficult decision.
My children (15, 17 and 19) are not so young anymore and they have all been vaccinated. However, I have no doubt that if they were younger, my wife and I would still vaccinate them once they became eligible. Vaccinations are arguably the greatest public health achievement of the past century, a fact that has only become more apparent over the past year. They are a collective good and as part of society we must respect the social contract to protect others as we would like to be protected ourselves.
This, of course, all depends on the FDA’s approval of the vaccines for younger children. That could happen before the end of this year. It will take longer to control for rarer side effects as doses are given in large numbers, meaning mandates for children at school may take longer after that.
After looking at this issue from all angles, I am faced with this as a parent: As variants become more and more contagious, we are faced with the reality that almost everyone is likely to get COVID-OVID-19 at some point unless they are vaccinated. Even for children, the latter is so, so much better than the former. That makes the decision quite easy. In the interest of everyone, we must start vaccinating younger children as soon as possible.